Substitution of mitoxantrone for doxorubicin in a multidrug chemotherapeutic protocol for first-line treatment of dogs with multicentric intermediate- to large-cell lymphoma

Marquardt, Taya M.; Lindley, Stephanie E. S.; Smith, Annette; Cannon, Claire M.; Rodríguez, C. O.; Thamm, Douglas H.; Childress, Michael O.; Northrup, Nicole C.

doi:10.2460/javma.254.2.236

Cited by 4 publications

(3 citation statements)

References 16 publications

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“…25,26 The substitution of doxorubicin for mitoxantrone in a multiagent protocol (CMOP) in dogs has been evaluated in two different studies that did not show any negative impact on survival times in these patients compared with CHOP, and would suggest that CMOP is an acceptable alternative chemotherapy protocol for canine lymphoma patients that cannot tolerate doxorubicin. 11,12 However, less is known about the clinical implications of this substitution in cats, in which the use of doxorubicin can be limited by its nephrotoxic effects, particularly in the older population predisposed to cancer. While multiagent chemotherapy is the mainstay of treatment for feline lymphoma, there is currently no consensus on the optimum chemotherapy protocol as currently no prospective evidence exists to definitively conclude a superior protocol as, unlike in their canine counterparts, the benefits of the addition of doxorubicin to a multiagent chemotherapy protocol has not been well established in cats.…”

Section: Discussionmentioning

confidence: 99%

“…10 Comparisons of canine lymphoma patients treated with CMOP have shown comparable response rates, PFIs and MSTs but fewer side effects than those treated with CHOP. 11,12 Although cats are less sensitive to the cardiotoxic effects of doxorubicin, the other adverse effects of doxorubicin chemotherapy, including the potential for nephrotoxicity, warrant the assessment of alternative chemotherapeutics. [13][14][15] For this reason, it may be of benefit to consider a multidrug protocol that replaces doxorubicin with an alternative agent.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of a multiagent chemotherapy protocol combining vincristine, cyclophosphamide, mitoxantrone and prednisolone (CMOP) for treatment of feline intermediate–large cell lymphoma

Webster,

McNaught,

Morris

2024

Journal of Feline Medicine and Surgery

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Objectives The aim of this study was to determine response rates, median progression-free intervals (PFIs) and median survival times (MSTs) for cats with intermediate–large cell lymphoma treated with a vincristine, cyclophosphamide, mitoxantrone and prednisolone (CMOP) protocol. A secondary objective was to determine the tolerability of mitoxantrone used within this multiagent protocol. Methods The medical records of 31 cats treated at a single institution between 2009 and 2022 were reviewed to identify suitable cases. Cats were included in the study if they had a confirmed diagnosis of intermediate–large cell lymphoma, had received a CMOP protocol as first-line treatment and had completed at least one 4-week cycle of this protocol. Modifications allowed in the protocol included the use of l-asparaginase, vinblastine substitution for vincristine, chlorambucil substitution for cyclophosphamide and dexamethasone or methylprednisolone substitution for prednisolone. Results The overall response rate was 74% (n = 23), with 45% (n = 14) achieving complete remission (CR), 29% (n = 9) achieving partial remission (PR) and 26% (n = 8) achieving stable disease (SD). The Kaplan–Meier median PFI and MST were 139 days and 206 days, respectively. Responders (CR or PR) had a significantly longer ( P <0.001) median PFI and MST compared with non-responders (SD) (176 days vs 62 days, and 251 days vs 61 days, respectively). Cats that achieved CR had a significantly longer median PFI and MST ( P <0.001) at 178 days and 1176 days, respectively. The 6-month and 1- and 2-year survival rates in cats with CR were 64%, 57% and 35%, respectively. Treatment with mitoxantrone was generally well tolerated, with no cats experiencing Veterinary Cooperative Oncology Group adverse effects above grade 2. Conclusions and relevance The CMOP protocol is an alternative and well-tolerated treatment for cats with intermediate–large cell lymphoma. As demonstrated with previous chemotherapy protocols, cats that respond to treatment, particularly those that achieve CR, are likely to have more durable responses.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of a multiagent chemotherapy protocol combining vincristine, cyclophosphamide, mitoxantrone and prednisolone (CMOP) for treatment of feline intermediate–large cell lymphoma

Webster,

McNaught,

Morris

2024

Journal of Feline Medicine and Surgery

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“…2018, Marquardt et al . 2019). In situations where combination therapy is not achievable, single‐agent therapy has been described, with most clinicians utilising doxorubicin, often in combination with prednisolone.…”

Section: Introductionmentioning

confidence: 99%

Cyclophosphamide and prednisolone for chemotherapy naïve B cell multicentric lymphoma in dogs: 32 cases (2017–2021)

Todd¹,

Thomas²,

Nguyen³

2021

J of Small Animal Practice

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Objectives The aim of this study was to characterise the response rate and toxicity profile of cyclophosphamide and prednisolone given to dogs with newly diagnosed, chemotherapy naïve, B cell multicentric lymphoma. Materials and Methods Dogs with diagnosed with B cell lymphoma naïve to chemotherapy treatment were prospectively identified at the author's institution (2017 to 2021) and given cyclophosphamide as their initial chemotherapeutic agent in combination with prednisolone with owner's consent. Signalment, laboratory findings, stage, treatment response and toxicity were recorded. Results Thirty‐two dogs were included in the study. The overall response rate in this population of dogs was 84%. Twenty dogs (62%) had a partial response, three dogs (9%) had a complete response, four dogs (12%) had stable disease and five dogs (15%) had progressive disease. Side effects were noted in 47% of patients, with neutropaenia being the most commonly reported. Clinical Significance Cyclophosphamide and prednisolone were well‐tolerated with limited side effects. The response rate observed in this cohort of dogs with chemotherapy‐naïve B cell multicentric lymphoma is promising. Further comparative studies are required to confirm the safety and effectiveness of this intervention.

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Maintenance treatment in relapsed canine lymphoma after a short L-CHOP protocol

Troedson

Fejös²,

Zablotski³

et al. 2021

Tierarztl Prax Ausg K Kleintiere Heimtiere

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Objective A number of different rescue protocols for relapsed canine multicentric large-cell lymphoma have been described. The aim of this pilot study was to evaluate the efficacy of a maintenance treatment in dogs that experienced a second complete remission after a short L-CHOP-rescue protocol. Material and methods Included in the study were dogs experiencing the first lymphoma relapse during a treatment-free period which were treated with a short L-CHOP protocol, achieved a complete remission and were afterwards treated with a continuous maintenance phase (MP) protocol. The L-CHOP protocol consisted of weekly treatments, with at least 3 additional treatments following complete remission. Thereafter the MP protocol with 2-week treatment intervals was conducted. It consisted of alternating oral home administration of different alkylating agents and one intravenously administered cytotoxic agent of a different mechanism of action. The dogs were presented either every 4 or 6 weeks for intravenous treatment and at this time a complete blood count was performed. The durations of the first remission, disease-free interval and overall survival time were evaluated. Results A total of 20 dogs were included in the study. A median of 7 weekly applications were given before the treatment was switched to the MP protocol. During MP, 14 dogs were treated intravenously every 6 weeks and 6 dogs every 4 weeks. Haematological adverse events were mainly mild. During the L-CHOP-protocol, one septic event occurred, and 2 dogs were hospitalized due to gastrointestinal adverse events. No patient required hospitalization during the MP. Fifteen dogs completed at least one cycle in the MP and a median of 8.5 chemotherapeutic treatments were administered. The median disease-free interval was 264 days and the median overall survival time was 737 days. Conclusion and clinical relevance The protocol was generally well tolerated. Since 5 patients showed disease progression during the first cycle of the MP, dogs should ideally be evaluated for minimal residual disease before being switched to the MP. The case number in the presented study was low and the treatment relatively heterogeneous. Therefore, more dogs have to be treated with the proposed protocol before general recommendations can be made.

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Substitution of mitoxantrone for doxorubicin in a multidrug chemotherapeutic protocol for first-line treatment of dogs with multicentric intermediate- to large-cell lymphoma

Cited by 4 publications

References 16 publications

Evaluation of a multiagent chemotherapy protocol combining vincristine, cyclophosphamide, mitoxantrone and prednisolone (CMOP) for treatment of feline intermediate–large cell lymphoma

Evaluation of a multiagent chemotherapy protocol combining vincristine, cyclophosphamide, mitoxantrone and prednisolone (CMOP) for treatment of feline intermediate–large cell lymphoma

Cyclophosphamide and prednisolone for chemotherapy naïve B cell multicentric lymphoma in dogs: 32 cases (2017–2021)

Maintenance treatment in relapsed canine lymphoma after a short L-CHOP protocol

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